None listed
Conditions
Brief summary
In Australia there are currently >425,000 people living with a stroke related disability and this number is only set to rise with the aging population and burgeoning epidemics of diabetes and obesity. In the chronic post-stroke period the only way to improve function and independence is through rehabilitation. Constraint-Induced Movement Therapy (CIMT) is the current best practice for upper-limb rehabilitation. Recent evidence suggests that CIMT's success may be due to one component, the transfer package which encourages patients to be more responsible for their own recovery. The package includes daily revision of a behavioural contract, Motor Activity Log (an index of how well the patient can complete everyday activities with their more-affected hand), daily activity diary, daily schedule (including home practice), and patient-centred goal setting and problem solving. Preliminary research also suggests that this package can be transferred to other intensive therapies with equal benefits. However, such intensive programs are rarely used in routine clinical practice due to lack of staff and resources. This study aims to investigate the use of the transfer package delivered via telehealth in current hospital outpatient rehabiltation programs. I hypothesise that patients receiving the transfer package will have greater improvements in function and will not require recurrent outpatient programs thus reducing costs and improving the capacity of the outpatient hospital system.
Interventions
To compare the functional outcomes of providing a telehealth transfer package to post stroke patients enrolled in an 8 week Outpatient/Day patient upper-limb therapy program with those receiving usual care alone. Group 1 will receive the transfer package for the 2nd and 3rd week (2 weeks) of their Outpatient/Day patient program. The transfer package will be delivered via individual (one-on-one) face-to-face sessions 1x per week after the patients formal therapy visit and via individual (one-on-o
To compare the functional outcomes of providing a telehealth transfer package to post stroke patients enrolled in an 8 week Outpatient/Day patient upper-limb therapy program with those receiving usual care alone. Group 1 will receive the transfer package for the 2nd and 3rd week (2 weeks) of their Outpatient/Day patient program. The transfer package will be delivered via individual (one-on-one) face-to-face sessions 1x per week after the patients formal therapy visit and via individual (one-on-one) telehealth sessions 4x per week. All sessions will occur on weekdays and be approximately 30-minutes long in duration. They will then have 1 additional face-to face session each week for the following 4 weeks. The transfer package includes: a behavioural contract where the patient and applicant will decide which activities the patient will complete with their more-affected hand. This will be reviewed each day by the therapist and patient during their session and amended accordingly; a daily motor activity log; a daily activity diary, a daily schedule of home practice prescribed by the treating therapists and a list of optional motor-function specific supplementary activities the patient can complete at their leisure. Goal setting and problem solving will also be discussed at each setting and will reiterate practice from formal therapy sessions. The telehealth component will be delivered via Skype on the patient’s usual household computer. Patients will be given clear instructions on how to download and use Skype. The intervention will be delivered by an Accredited Exercise Physiologist who has a PhD in upper-limb rehabilitation after stroke. The therapist will monitor adherence with daily sessions and they will keep a log the completed transfer package for each day. Group 2 will receive their usual 8 week Outpatient/Day patient program,
Sponsors
St Vincent's Centre of Applied Medical Research
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
INCLUSION CRITERIA Stroke patients receiving an Outpatient or Day patient rehabilitation program will be recruited from St Vincent’s Hospital’s Sacred Heart Allied Health Services. Inclusion criteria are: >18 years of age, ischaemic or haemorrhagic stroke with an upper limb deficit, cognitively competent with a MMSE >24, able to communicate in English and participating in an Outpatient/Day patient program to improve upper-limb function (i.e. Occupational Therapy).
Exclusion criteria
EXCLUSION CRITERIA Exclusion criteria are: patients participating in other upper-limb rehabilitation research trials during the 8 week program period, blindness, deafness, no carer for those with low function and poor balance and no internet or computer access.
Outcome results
None listed